Provider Demographics
NPI:1952443962
Name:FISHER, CRAIG D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:D
Last Name:FISHER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N WASHINGTON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3410
Mailing Address - Country:US
Mailing Address - Phone:571-970-2418
Mailing Address - Fax:
Practice Address - Street 1:405 N WASHINGTON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3410
Practice Address - Country:US
Practice Address - Phone:571-970-2418
Practice Address - Fax:703-533-9433
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015967-1103T00000X
VA0810003396103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist